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Related Concept Videos

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug binding...
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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...

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Impact of Pre-Liver Transplant Treatments on the Imaging Accuracy of HCC Staging and Their Influence on Outcomes.

Eloisa Franchi1, Daniele Eliseo Dondossola1,2, Giulia Maria Francesca Marini1,2

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Cancers
|March 13, 2024
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Pre-transplant radiological staging for liver cancer (hepatocellular carcinoma) often mismatches pathology, especially with more nodules. Multiple treatments before liver transplantation reduce staging accuracy and negatively impact patient survival outcomes.

Keywords:
concordancehepatocarcinomaliver transplant

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Area of Science:

  • Hepatobiliary Surgery
  • Transplant Oncology
  • Radiological Imaging

Background:

  • Liver transplantation (LT) outcomes for hepatocellular carcinoma (HCC) depend on accurate pre-transplant staging.
  • Discrepancies between radiological and pathological HCC staging are common and impact treatment decisions.

Purpose of the Study:

  • To evaluate the concordance between pre-LT radiological and post-transplant pathological HCC staging.
  • To identify factors associated with poor concordance and their impact on LT outcomes.

Main Methods:

  • Retrospective analysis of 134 LT cases with HCC diagnosis between 2013 and 2018.
  • Definition of concordance as comparable tumor burden between imaging and pathology.
  • Comparison of outcomes between concordant (Co) and non-concordant (nCo) groups.

Main Results:

  • Low concordance (24%) between pre-LT radiology and pathology was observed.
  • Higher nodule count, diameter, and pre-LT treatments were associated with non-concordance.
  • While concordance itself didn't affect survival, >3 pre-LT treatments reduced disease-free survival.

Conclusions:

  • Pre-LT radiological staging for HCC shows low concordance with pathology, particularly with numerous nodules.
  • Multiple pre-LT treatments decrease imaging accuracy and negatively affect post-transplant survival.
  • Accurate staging is crucial for optimizing liver transplantation outcomes in HCC patients.